A coil held against the head generates short magnetic pulses that stimulate nerve cells in a small area of the cortex - as an outpatient, without surgery or anaesthesia.
The German National Care Guideline on unipolar depression (2022) recommends rTMS: it “should be offered for treatment-resistant depressive episodes” (recommendation 7-29, grade B). Other indications are treated as an individual treatment attempt. View the guideline
The physical principle is well understood; the biological pathways are still being researched. Three levels interlock:
A short, strong current pulse runs through the coil - none of it enters the head. What acts is the magnetic field it creates: it passes through scalp and skull unimpeded and stimulates the nerve cells in the target area. The field strength is roughly that of an MRI scanner.
Whether an area is stimulated or dampened depends mainly on the pulse frequency: high-frequency stimulation (around 10 Hz) increases excitability, low-frequency stimulation (around 1 Hz) reduces it. In depression, the left dorsolateral prefrontal cortex is usually stimulated at high frequency - a region that imaging studies often find underactive.
A single pulse lasts only milliseconds. Only repetition across a treatment series - hence "repetitive" - leads to longer-lasting changes in signal transmission between nerve cells. Effects on neurotransmitters and on the coupling between distant brain areas have been described, among others.
From the first conversation to the end of the series - outpatient and without after-effects.
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You sit awake and relaxed in a treatment chair with the coil resting against the side of your head. The pulses feel like a light tapping on the scalp - many find it pleasant, some mildly uncomfortable to slightly painful, and we adjust the settings accordingly. No anaesthesia or sedation is needed, your ability to drive is unaffected, and you can go home immediately afterwards.
rTMS for depression has been the subject of controlled trials for more than two decades and is listed as a treatment option in the German S3/National Care Guideline on unipolar depression (AWMF 2022). Three of those studies, each with its limitations:
Brunoni, Chaimani, Moffa et al. · JAMA Psychiatry
Hochfrequenz-rTMS: Odds Ratio 3,07 (95%-KI 2,24-4,21) fuer Ansprechen gegenueber Schein
Context: Fuer seltenere Protokolle lagen nur wenige Studien vor, die Schaetzungen sind dort entsprechend unpraeziser.
View studyBlumberger, Vila-Rodriguez, Thorpe et al. · The Lancet
HAMD-17 sank in beiden Gruppen praktisch identisch (23,5 -> 13,4 unter 10 Hz; 23,6 -> 13,4 unter iTBS) - iTBS war der 10-Hz-rTMS nicht unterlegen
Context: Nichtunterlegenheitsstudie ohne Sham-Arm - sie belegt die Gleichwertigkeit beider aktiver Protokolle, nicht die Überlegenheit gegenüber einer Scheinbehandlung (dafür stehen die sham-kontrollierten Studien). Offene Behandlung mit verblindeter Auswertung; untersucht wurde therapieresistente Depression.
View studyCarpenter, Janicak, Aaronson et al. · Depression and Anxiety
Ansprechrate (klinisch, CGI-S): 58,0%; Remission: 37,1%
Context: Naturalistische Beobachtung ohne Kontroll-/Sham-Gruppe - ein Placebo-Anteil lässt sich nicht herausrechnen, kein randomisiertes Design. Die Stärke liegt in der Übertragbarkeit auf die reale Versorgungspraxis, nicht im kausalen Wirksamkeitsnachweis (den liefern die RCTs).
View studyBefore the first treatment we determine your motor threshold: the coil is positioned over the motor cortex and the intensity adjusted until a visible twitch of the hand muscles appears. The treatment intensity is then set as a percentage of that personal threshold - every head conducts the magnetic field slightly differently.
The target area over the prefrontal cortex is located using standardised head measurements (the Beam F3 method, based on the international 10-20 system). We deliberately do not work with neuronavigation: we do not offer image-guided targeting based on an individual MRI for rTMS.
Locating the target by head measurements is the common approach for the established depression protocols. Whether neuronavigation improves treatment outcomes is judged differently across the literature. Accordingly, we do not run study protocols that require individual image-guided targeting.
For transcranial pulse stimulation (TPS) we do work MRI-guided - there, navigation is part of the procedure. To the TPS page
Private health insurers and civil-service assistance schemes usually reimburse rTMS fully or partly, depending on the policy; we provide the medical rationale. Statutory health insurers do not list the procedure in their benefits catalogue, which makes rTMS a self-pay service there: billing follows the German scale of medical fees (GOÄ) per session, coming to about 1,975 € for a series of 20 sessions. The introductory conversation is free of charge and without obligation.
Whether rTMS is an option in your situation is best clarified in conversation. Write to us and we will get back to you.
